Sally Johnson And Daniel Hales Case Study


Sally Johnson a thirty-year-old first-time woman to be pregnant but had experienced a miscarriage (G2P0). She is married to Daniel Hales for five years now, who is happy and supportive concerning the pregnancy as well as the pregnancy that was an imminent birth of a child. It is her last stage of pregnancy and she will undergo three stages of delivery of her healthy child Matilda with the help of midwife; Lauren.


During the first trimester, Sally had had an indecisive pregnancy, undergoing vomiting and nausea; morning sickness for the first fourteen weeks of pregnancy. According to Stables and Rankin (2010, p. 487), during the onset of a pregnancy, the body experiences several changes, ranging from common to expected adjustments. While Sally experienced vomiting and nausea, other changes that she might have undergone could be, swelling due to fluid retention or even vision changes. However, the hormones responsible for these physiological changes are due to a sudden and dramatic increase in progesterone and estrogen. They also influence the adjustment in the number of other body hormones, which affect the moods, develop glow of pregnancy, alter the physical impact of exercise as well as activities of the body, and most significantly assist in the development of the fetus.


The main hormones are estrogen and progesterone during the first trimester of pregnancy. A woman such as Sally will produce more of estrogen, which according to Stables and Rankin (2010, p. 487), enables the uterus and the placenta to improve vascularization or rather the formation of blood vessels, transfer nutrients and support the growth of the child. The hormone increases steadily during pregnancy and in the third trimester, it is at its peak. This increase in estrogen level causes nausea and vomiting. Progesterone, on the other hand, causes laxity of the joints and ligaments throughout the body, and the increase in the size of the internal framework such as the ureters. This hormone was the reason why Sally was sleeping early and mostly felt tired.

Sally’s pregnancy was confirmed by her general practitioner (GP) who also undertook Sally’s antenatal screening. The results indicated that Sally’s blood group was O negative, possibly the reason why she miscarried in her first pregnancy. According to Pincombe et al (2015, p. 550), having an O negative blood group means one is a universal donor since the blood lack antigens, thus it is accepted by all immune systems. So during birth, when a pregnant woman such as Sally, there could be a complication if the Daniel had a different type of blood, meaning that the child she will bear might pose threat to her. First of all, Sally is Rhesus negative (Rh -), and the blood type of the child will affect the antibodies of Sally body produces as an immune response to a foreign matter within her bodies, such as a sperm, bacteria or embryo. When Sally; Rh – a woman has a child with Rh +, it is referred to as Rh incompatibility, where Sally’s body will treat the Rh proteins found in her child’s blood as foreign and produce antibodies to attack them. In case these two blood mix in any way, the condition will be Rhesus disease.

Group B Streptococcus or rather Group B beta-haemolytic Streptococcus (S. agalactiae; GBS or GBBS) is a Gram-positive aerobic coccobacillus that was first linked with bovine mastitis thus its so-called agalactiae tom signifies ‘lack of milk’. Regrettably, according to Pincombe et al. (2015, p. 540), it is not limited to cows; it can bring about an intrusive disease (pyemia) of a newborn child in humans. It can occur within a week since conception. It is a leading cause of meningitis, sepsis, and death among new infants. The two screening options for GBS are the ‘Risk-based protocol meant for treatment of women with certain risk factor during labour, and the Screening-based protocol that entails cultures at 35-7 weeks gestation, offering intrapartum prophylaxis to all women possessing positive cultures. While both screening options involve high rates of intrapartum antibiotic application, the rates of neonatal GBS sepsis is reduced, the screening-based protocol has a risk of doubling the rate of risk for both, while the risk-based protocol reveals much less number of babies and women to antibiotics while inhibiting basically all cessations from GBBS blood poisoning.


Transcutaneous Electric Nerve Stimulation (TENS) machines, which have lead, linked to sticky pads known as electrodes. The device that is attached to the skin of a person is used to transmit small impulse of electricity aiding in easing of pain Stables and Rankin (2010, p523 and 524). The Gate Control Theory of pain affirms that non-painful admissions seal the gates to pain input, thus averting sensation of pain from being transmitted to the Central Nervous System (CNS). The use of the TENS machine, specifically the electrical current stimulates nerve fibres that carry pain signal by blocking them from transmitting pain sensation to the CNS, thus acting as the gate, and relieves pain.

Labour pain occurred between the thirty-seventh and forty-second weeks, the time when Sally at 2 a.m. in the morning when she experienced labour pains. Stables and Rankin link the timing to fatal brain function through the adrenocorticotrophic hormone (ACTH) as identified by Stables and Rankin (2010, p. 487), as well as the pituitary-adrenal axis. The progesterone that was accumulating since the first stage is metabolized to oestrogen. It slowly heightens the sensitivity of the uterus to oxytocin and prostaglandins generated by the maternal tissues and foeto-placental unit.

On the second state of birth, Sally began to feel strong urges to bear down and the midwife encouraged her to follow her body instincts. This was her second stage of labor that begins with complete dilation of the cervix. It is when the foetal head descends due to the force of the uterine contractions as well as expanse the walls of the pelvis and vagina as confirmed by Stables and Rankin (2010, p. 540 and 541). The maternal position she resumed at this stage was partially sitting or half-lying where the trunk leans backward and might be supported with pillows behind the back, knees, and arms, as well as Daniel, was offering support, slightly sitting behind Sally to help with the pulling of the knees up. The essence of this position is to lessen pain, linked with fewer abnormalities of the infant’s heartbeat, reduces the possibility of using forceps to deliver and results to a much earlier delivery.

In the third stage of labour, Sally requested to be administered the modified active management of the thirds stage of labour, which is the expulsion of the placenta and membranes and concludes with the control of bleeding. There are three forms of management according to Stables and Rankin (2010, p. 550), and all require vigilance; active management, modified active management, and physiological management. The active management entails providing a prophylactic uterotonic, early cord clenching as well as regulated cord haulage to deliver the placenta. Modified active management involves an application of some of the components of the active management but not all, in which Lauren; the midwife waited for the umbilical cord to cease pulsating before administering the oxytocic to aid in the delivery of the placenta. Physiological management is the delivery of the placenta without the routine application of all those components of care.


Postpartum haemorrhage is the loss of excessive blood after placental delivery. However, according to Stables and Rankin (2010, p 548 and 549), physiological processes involved to avert further loss of blood involve when separation of the placenta is complete, the upper uterine segment strongly contract to inflict the placenta into the lower uterine pulling the membranes. The spiral fibres rapidly contract around the torn maternal tissues to prevent blood loss.

The transition of foetal to extra-uterine life relies on a slow adaptation of the fetal circulation. According to Stables and Rankin (2010, p. 650), there are a number of anatomical adjustments that require to be developed specifically on the interplay of the cardiovascular and respiratory frameworks that authenticate and support the independent life of the neonate. The breaking up of the neonate from the placental circulation originates from the abeyance of the flow of blood that leads to the failure of the umbilical arteries and veins. The hypogastric arteries and the ductus venosus slowly fibrosis, yielding to upholding ligaments. At the right atrium, blood flow reduces leading to falling of pressure at the right atrial, as a result, the large volume of blood is held in tiny systemic sections that heighten systemic vascular resistance (SVR) and boost arterial and venous goes back to the lungs and heart. While the significant quantities of blood are drawn back from the lungs to the left atrium through the pulmonary vein, the left atrial pressure increases cramping the foramen ovale. The original balancing of pressure in the two atria supports the flaps of the foramen ovale in position, halting the lurching of blood from the right to left atrium. As the child takes the first breath, the lungs expand and the oxygenated air is inspired, displacing the pulmonary fluid further and triggering an operation crucial to competently respiration and pulmonary gas exchange.

Within the 30 minutes of birth, baby Matilda has self-latched on the breast of her mother while being skin to skin. The hormones involved in the initiation and maintenance of lactation are oestrogen, progesterone, and prolactin. The combination of progesterone and oestrogen during pregnancy inhibits the secretion of prolactin from the pituitary gland. Immediately after delivery, the expulsion of the placenta leads to the loss of its supply of hormones and its decline of hormone production by the ovaries. Oestrogen continues to circulate, fostering secretion of prolactin by the pituitary gland, leading to lactation. For a continuous supply of milk, the pituitary gland secretes adrenocorticotropic hormone.

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Effective midwifery requires comprehension of all the activities and processes that take place and require to be undertaken during the three stages of labour. They are essential in determining the survival of the mother and the child. As depicted in Sally’s scenario, Lauren, the midwife had pretty enough comprehension of her role in aiding Sally who had an O negative blood group, to deliver baby Matilda both alive and healthy.


  • Pincombe, J., Thorogood, C., Tracy, S. K., & Pairman, S. (2015). Midwifery-E-Book: Preparation for Practice. Elsevier Health Sciences.
  • Stables, D., & Rankin, J. (2010). Physiology in childbearing : with anatomy and related biosciences. Retrieved from Created from griffith on 2018-08-31 17:44:25.

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